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Texas rates for HCPCS A5514

For diabetics only, multiple density insert, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

Facilitymedian $55 · 10th–90th $35–$1620%10%10th90th$55Professionalmedian $33 · 10th–90th $25–$450%20%10th90th$33$20.0$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $34.67 / $38.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $34.67 / $44.67
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $51.29 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $66.07 / $151.36
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $25.70
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $43.65 / $67.61
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $741.31 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $35.48
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $407.38 / $407.38
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $54.95 / $81.28
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $34.67 / $47.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $2,754.23
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $54.95 / $81.28
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $35.48
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $37.15 / $43.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $31.62 / $38.90
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95